O que é Testosterone Replacement Therapy?
Testosterone Replacement Therapy (TRT) refers to the medical tratamento of male hypogonadism — a clinical condition characterised by the failure of the testes to produce adequate testosterone, resulting in symptoms that significantly affect quality of life. TRT is approved by the Agência Europeia de Medicamentos (EMA) for the tratamento of hypogonadism in adult men when testosterone deficiency has been confirmed by both clinical symptoms and repeated laboratory testing.
TRT involves supplementing the body’s testosterone levels with exogenous (externally produced) testosterone in a variety of EMA-approved formulations. It is not a tratamento for age-related testosterone decline in otherwise healthy men without confirmed hypogonadism.
Como funciona Testosterone work in the body?
Testosterone is the primary male sex hormone (androgen), produced predominantly in the Leydig cells of the testes under the regulation of luteinising hormone (LH) from the pituitary gland. It plays essential roles throughout the body:
- Sexual function: Maintains libido, supports erectile function, and drives sexual development during puberty
- Muscle and bone: Promotes muscle protein synthesis and bone mineral density maintenance
- Red blood cell production: Stimulates erythropoietin production in the kidneys, supporting red blood cell formation
- Energy and mood: Influences energy levels, mood, cognitive function, and overall sense of well-being
- Body composition: Influences the distribution of fat and lean muscle mass
- Spermatogenesis: Supports (but does not solely drive) sperm production — this is also regulated by FSH and intratesticular testosterone levels
In hypogonadism, inadequate testosterone production leads to a characteristic cluster of symptoms. TRT replaces the deficit, restoring physiological testosterone levels and alleviating symptoms.
Para quem é TRT for?
TRT is indicated for adult men with documented hypogonadism, defined as:
- Clinical symptoms consistent with low testosterone: reduced libido, erectile dysfunction, fatigue, decreased muscle mass, increased body fat, mood disturbance, poor concentration, reduced body/facial hair, or reduced bone density, AND
- Biochemically confirmed low testosterone: Two separate morning serum total testosterone measurements below the laboratory reference range (typically <12 nmol/L or <300 ng/dL, but reference ranges vary by laboratory and assay)
Types of hypogonadism:
- Primary hypogonadism (testicular failure): Caused by conditions such as Klinefelter syndrome, testicular injury, mumps orchitis, chemotherapy
- Secondary hypogonadism (hypothalamic-pituitary failure): Caused by conditions such as pituitary tumours, haemochromatosis, hyperprolactinaemia, or Kallmann syndrome
TRT is not indicated for:
- Age-related decline in testosterone without confirmed hypogonadism
- Men with prostate cancer or breast cancer
- Men with polycythaemia (significantly elevated red blood cell count)
- Men with severe untreated obstructive sleep apnoea
- Men who wish to father children in the near term (without specialist co-management)
TRT Formulations and Dosagem
| Formulation | Examples | Frequency | Dose |
|---|---|---|---|
| Transdermal gel | Testogel, Testim, AndroGel | Daily | 25–75 mg/day |
| Long-acting injeção | Nebido (testosterone undecanoate) | Every 10–14 weeks | 1000 mg |
| Short-acting injeção | Testosterone enanthate / cypionate | Every 2–4 weeks | 100–250 mg |
| Buccal comprimido | Striant | Twice daily | 30 mg |
The prescribing médico will select the most appropriate formulation based on paciente preference, lifestyle, compliance, and clinical considerations.
Transdermal gels: Applied daily to clean, dry skin (shoulders, upper arms, or abdomen — not the genitals). Allow to dry before dressing. Wash hands after application. Avoid skin-to-skin contact with the application site with women, children, or pregnant women until the gel has dried.
Nebido (long-acting injeção): Given by a healthcare professional as an intramuscular injeção every 10–14 weeks. Provides stable testosterone levels without daily application.
Efeitos secundários
Efeitos secundários comuns
- Acne or oily skin
- Increased red blood cell count (polycythaemia) — monitored via regular blood tests
- Fluid retention (mild oedema)
- Prostate-specific antigen (PSA) increase — monitoring required
- Increased libido (particularly early in tratamento)
- Mood changes
Menos comuns efeito secundários
- Sleep apnoea (may worsen pre-existing sleep apnoea)
- Gynaecomastia (breast tissue development — related to testosterone aromatisation to oestradiol)
- Male pattern hair loss (in genetically predisposed men)
- Testicular atrophy (due to suppression of natural testosterone production and LH)
- Skin reactions at the application site (gels) or injeção site
Serious concerns requiring monitoring
- Cardiovascular risk: The relationship between TRT and cardiovascular events is complex and remains an area of ongoing research. Men with pre-existing cardiovascular disease should discuss the risk-benefit profile with their médico.
- Polycythaemia: Excess red blood cell production increases thrombosis risk — haematocrit must be monitored
- Prostate health: TRT may stimulate prostate tissue growth; PSA must be monitored. TRT is contraindicated in men with prostate cancer.
Monitoring during TRT
Regular medical monitoring is essential throughout TRT. A médico will typically assess:
| Parameter | Frequency |
|---|---|
| Serum testosterone | 3 months, then annually |
| Full blood count (haematocrit) | 3 months, then annually |
| PSA (prostate-specific antigen) | Annually (or more frequently in older men) |
| Liver function | Annually |
| Lipid profile | Annually |
| Digital rectal examination | As clinically indicated |
Como aceder a TRT online na Europa
Testosterone is a medicamento sujeito a receita médica (POM) and a controlled substance in most estados-membros da UE. It cannot legally be dispensed without a valid receita médica from a licensed medical professional.
Prescrivia operates as a technology intermediary: we do not prescribe medicamentos, employ médicos, or sell medicamentos. Our platform connects pacientes with independent EU-registered médicos who can conduct confidential online consultations.
Important note on TRT assessment: Diagnosing hypogonadism requires blood testing to confirm low testosterone levels. An online assessment is a first step — the médico may refer you for blood tests and will review the results before any prescribing decision is made.
The process:
- Complete uma avaliação de saúde: Describe your symptoms, relevant medical history, and any previous testosterone testing or tratamento.
- Avaliação médica and blood test referral: An independent EU-registered médico reviews your assessment. If clinically indicated, they will refer you for appropriate blood tests.
- Results review and receita médica: If test results confirm hypogonadism and TRT is appropriate, the médico may issue a receita médica.
- Dispensa na farmácia: The receita médica is sent to a licensed EU farmácia partner for dispensing and direct delivery.
Important: A Prescrivia não garante that a receita médica will be issued. All prescribing decisions are made independently by qualified medical professionals based on confirmed clinical and biochemical criteria.
Informação de segurança importante
TRT is contraindicated in men who:
- Have prostate cancer or breast cancer
- Have polycythaemia (significantly raised haematocrit)
- Have severe untreated heart failure
- Have uncontrolled severe sleep apnoea
- Are allergic to testosterone or any excipient in the formulation
Informe o seu médico if you:
- Are using TRT and experience chest pain, breathlessness, leg swelling, or symptoms of stroke
- Are taking anticoagulants such as warfarin (testosterone can potentiate anticoagulant effect)
- Are taking insulin or other antidiabetic medicamentos (testosterone may improve insulin sensitivity — blood glucose monitoring may need adjustment)
- Have or have had liver tumours
TRT is not the same as anabolic steroid misuse: TRT restores physiological testosterone levels to within the normal range. It is not the same as supraphysiological doses of testosterone or anabolic steroids used without medical supervision, which carry substantially greater health risks.
Fontes
Medical information on this page is based on the following sources:
- Agência Europeia de Medicamentos (EMA). Testogel (testosterone) — Summary of Product Characteristics. Available at: ema.europa.eu
- European Association of Urology (EAU). Guidelines on Male Hypogonadism. 2023. uroweb.org
- Organização Mundial da Saúde (WHO). Testosterone — Essential Medicines information. who.int
- Bhasin S, et al. Testosterone Therapy in Men with Hypogonadism: An Endocrine Society Clinical Practice Guideline. Journal of Clinical Endocrinology & Metabolism. 2018.
This content is reviewed periodically to reflect updated clinical guidance. It is provided for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional for advice relevant to your individual health circumstances.
Frequently asked questions
- O que é Testosterone Replacement Therapy utilizado para?
- Testosterone Replacement Therapy (TRT) is prescribed for male hypogonadism — a condition where the testes do not produce sufficient testosterone. Symptoms of low testosterone (low T) include reduced libido, erectile dysfunction, fatigue, reduced muscle mass, mood changes, and impaired concentration. TRT is only prescribed after blood tests confirm clinically low testosterone levels alongside appropriate symptoms.
- What are the different types of TRT available?
- Testosterone replacement is available in several formulations approved by the EMA: transdermal gels (applied daily to skin — Testogel, AndroGel, Testim), injectable testosterone (long-acting injeçãos such as Nebido/testosterone undecanoate every 10–14 weeks, or shorter-acting testosterone esters every 2–4 weeks), and buccal comprimidos (applied to the gum). The appropriate formulation is determined by a médico based on the paciente's preference, lifestyle, and clinical circumstances.
- Can TRT affect fertility?
- Yes. Exogenous testosterone suppresses the body's natural hormonal signals (LH and FSH) that stimulate sperm production. Men who wish to preserve or maintain fertility should discuss this with their médico before starting TRT. Alternative tratamentos such as human chorionic gonadotropin (hCG) or selective oestrogen receptor modulators (SERMs) may be considered for men with hypogonadism who wish to maintain fertility.
- Com que rapidez TRT improve symptoms?
- The timeline varies by symptom and individual. Sexual function and libido may improve within a few weeks. Energy, mood, and cognitive function often improve over 3–6 months. Muscle mass and body composition changes may take 6–12 months to become apparent. Bone density improvements require tratamento over 1–2 years. Regular monitoring by a médico is essential throughout tratamento.
- Posso obter TRT online na Europa?
- TRT is a medicamento sujeito a receita médica in all estados-membros da UE and requires confirmed diagnosis of hypogonadism via blood testing before a receita médica can be issued. You can access TRT evaluation through online intermediary platforms that connect you with independent EU-registered médicos. The médico will review your symptoms and, if appropriate, refer you for relevant blood tests before any prescribing decision is made.
A Prescrivia é apenas uma plataforma intermediária. Não prestamos serviços médicos, não prescrevemos tratamentos nem dispensamos medicamentos. Todas as decisões médicas são tomadas por médicos independentes registados na UE. Todos os medicamentos são dispensados por farmácias licenciadas na UE. Esta plataforma facilita a ligação entre pacientes e prestadores de cuidados de saúde.